diff --git a/clang-tools-extra/clangd/Preamble.h b/clang-tools-extra/clangd/Preamble.h
--- a/clang-tools-extra/clangd/Preamble.h
+++ b/clang-tools-extra/clangd/Preamble.h
@@ -182,6 +182,7 @@
   std::vector<Diag> PatchedDiags;
   PreambleBounds ModifiedBounds = {0, false};
   const PreambleData *Baseline = nullptr;
+  std::vector<PragmaMark> PatchedMarks;
 };
 
 } // namespace clangd
diff --git a/clang-tools-extra/clangd/Preamble.cpp b/clang-tools-extra/clangd/Preamble.cpp
--- a/clang-tools-extra/clangd/Preamble.cpp
+++ b/clang-tools-extra/clangd/Preamble.cpp
@@ -15,7 +15,9 @@
 #include "Protocol.h"
 #include "SourceCode.h"
 #include "clang-include-cleaner/Record.h"
+#include "index/CanonicalIncludes.h"
 #include "support/Logger.h"
+#include "support/Path.h"
 #include "support/ThreadsafeFS.h"
 #include "support/Trace.h"
 #include "clang/AST/DeclTemplate.h"
@@ -27,6 +29,7 @@
 #include "clang/Basic/TokenKinds.h"
 #include "clang/Frontend/CompilerInvocation.h"
 #include "clang/Frontend/FrontendActions.h"
+#include "clang/Frontend/PrecompiledPreamble.h"
 #include "clang/Lex/HeaderSearch.h"
 #include "clang/Lex/Lexer.h"
 #include "clang/Lex/PPCallbacks.h"
@@ -42,6 +45,7 @@
 #include "llvm/ADT/StringExtras.h"
 #include "llvm/ADT/StringMap.h"
 #include "llvm/ADT/StringRef.h"
+#include "llvm/Support/Casting.h"
 #include "llvm/Support/Error.h"
 #include "llvm/Support/ErrorHandling.h"
 #include "llvm/Support/FormatVariadic.h"
@@ -50,10 +54,12 @@
 #include "llvm/Support/VirtualFileSystem.h"
 #include "llvm/Support/raw_ostream.h"
 #include <cstddef>
+#include <functional>
 #include <memory>
 #include <optional>
 #include <string>
 #include <system_error>
+#include <tuple>
 #include <utility>
 #include <vector>
 
@@ -566,6 +572,29 @@
     return NewD;
   }
 };
+
+std::vector<PragmaMark> getPragmaMarks(const ScannedPreamble &Modified) {
+  std::vector<PragmaMark> Marks;
+  for (size_t I = 0, E = Modified.Lines.size(); I != E; ++I) {
+    llvm::StringRef Line = Modified.Lines[I].ltrim();
+    size_t MarkOffset = Line.find("mark");
+    if (MarkOffset == Line.npos)
+      continue;
+    if (!Line.consume_front("#pragma"))
+      continue;
+    Line = Line.ltrim();
+    if (!Line.consume_front("mark"))
+      continue;
+    PragmaMark &PM = Marks.emplace_back();
+    PM.Trivia = Line.str();
+    PM.Rng.start.line = I;
+    // We are only skipping whitespaces and `#pragma` when calculating this
+    // offset, hence no need to care about utf-16.
+    PM.Rng.start.character = MarkOffset;
+    PM.Rng.end.line = I + 1;
+  }
+  return Marks;
+}
 } // namespace
 
 std::shared_ptr<const PreambleData>
@@ -849,6 +878,7 @@
   }
 
   PP.PatchedDiags = patchDiags(Baseline.Diags, *BaselineScan, *ModifiedScan);
+  PP.PatchedMarks = getPragmaMarks(*ModifiedScan);
   dlog("Created preamble patch: {0}", Patch.str());
   Patch.flush();
   return PP;
@@ -902,8 +932,7 @@
 llvm::ArrayRef<PragmaMark> PreamblePatch::marks() const {
   if (PatchContents.empty())
     return Baseline->Marks;
-  // FIXME: Patch pragma marks.
-  return {};
+  return PatchedMarks;
 }
 
 MainFileMacros PreamblePatch::mainFileMacros() const {
diff --git a/clang-tools-extra/clangd/unittests/PreambleTests.cpp b/clang-tools-extra/clangd/unittests/PreambleTests.cpp
--- a/clang-tools-extra/clangd/unittests/PreambleTests.cpp
+++ b/clang-tools-extra/clangd/unittests/PreambleTests.cpp
@@ -830,6 +830,10 @@
   }
 }
 
+MATCHER_P2(Mark, Range, Text, "") {
+  return std::tie(arg.Rng, arg.Trivia) == std::tie(Range, Text);
+}
+
 TEST(PreamblePatch, MacroAndMarkHandling) {
   Config Cfg;
   Cfg.Diagnostics.AllowStalePreamble = true;
@@ -848,13 +852,18 @@
 #ifndef FOO
 #define FOO
 #define BAR
-#pragma mark XX
+#pragma $x[[mark XX
+]]
+#pragma $y[[mark YY
+]]
 
 #endif)cpp");
     auto AST = createPatchedAST(Code.code(), NewCode.code());
     // FIXME: Macros and marks have locations that need to be patched.
     EXPECT_THAT(AST->getMacros().Names, IsEmpty());
-    EXPECT_THAT(AST->getMarks(), IsEmpty());
+    EXPECT_THAT(AST->getMarks(),
+                UnorderedElementsAre(Mark(NewCode.range("x"), " XX"),
+                                     Mark(NewCode.range("y"), " YY")));
   }
 }